Tag: Friedman

Reading of the Week: Preventing Postpartum Depression in Pakistan – the New Nature Med Study; Also, Deaths of Despair and ChatGPT & Abstracts

From the Editor

Imagine that you are asked to design a program to prevent depression in a population at risk. Would you hire psychiatrists? Look to nurses? Tap the expertise of psychologists? All three?

In the first selection from Nature Medicine, Pamela J. Surkan (of Johns Hopkins University) and her co-authors describe a study that focused on prevention. As they worked in Pakistan – a nation with few mental health providers by Western standards – they chose to train lay people, teaching them to deliver CBT. In their single-blind, randomized controlled trial, 1 200 women who were pregnant and had anxiety (but not depression) were given enhanced usual care or CBT. “We found reductions of 81% and 74% in the odds of postnatal MDE and of moderate-to-severe anxiety…” We discuss the paper and its implications.

In the second selection, Joseph Friedman and Dr. Helena Hansen (both of the University of California, Los Angeles) look at deaths of despair in the United States in a research letter for JAMA Psychiatry. Their work builds on the idea that some deaths are related to the hopelessness of a person’s social or economic circumstance; past publications focused largely on White Americans. Friedman and Hansen drew on more than two decades of data, including ethnicity, from a US database, finding a different pattern and that: “Rising inequalities in deaths of despair among American Indian, Alaska Native and Black individuals were largely attributable to disproportionate early mortality from drug- and alcohol-related causes…”

A recent survey finds that psychiatrists see AI as potentially helpful with paperwork and diagnosing patients. But could AI help you keep up with the literature? In the third selection from Annals of Family Medicine, Dr. Joel Hake (of the University of Kansas) and his co-authors used ChatGPT to produce short summaries of studies, then evaluated their quality, accuracy, and bias. “We suggest that ChatGPT can help family physicians accelerate review of the scientific literature.”


Continue reading

Reading of the Week: ECT – the New NEJM Review; Also, Ethnicity & Drug Overdoses (JAMA) and Neil Seeman on His Father (CMAJ)

From the Editor

He has tried different medications, and yet he continues to struggle. The months have turned into years. When he was last well, he worked two jobs and was physically active, hoping to run the Boston marathon one day. When I saw him, he explained that he has difficulty following the plot of a TV show. Asked if he had ever considered ECT, his eyes widened. “They still do that?”

In the first selection, we look at a new review paper on ECT from The New England Journal of Medicine. Drs. Randall T. Espinoza (of the University of California, Los Angeles) and Charles H. Kellner (of the Medical University of South Carolina) provide a concise summary of the latest evidence. They conclude: “ECT is a valuable treatment for several severe psychiatric illnesses, particularly when a rapid response is critical and when other treatments have failed.” We consider the paper and the ongoing stigma associated with the treatment.

In the second selection, Joseph R. Friedman and Dr. Helena Hansen (both of the University of California, Los Angeles) draw on American data to consider overdose deaths and ethnicity. The JAMA Psychiatry paper concludes: “In this cross-sectional study, we observed that Black individuals had the largest percentage increase in overdose mortality rates in 2020, overtaking the rate among White individuals for the first time since 1999, and American Indian or Alaska Native individuals experienced the highest rate of overdose mortality in 2020 of any group observed.”

And in the third selection, Neil Seeman (of the University of Toronto) considers the life and death of his father, Dr. Philip Seeman, the celebrated scientist who studied schizophrenia. In this CMAJ essay, he comments on dopamine and his father’s life work. And he also writes about his relationship and dying. “It was that giving ice chips to my father will forever remind me of how the sensation of touch can stir love, fetch memories, and offer solace.”


Continue reading

Reading of the Week: How Has Mental Health Changed Over COVID? Also, Goldbloom on Practice & the Pandemic (Globe) and a Reader Responds to Psilocybin

From the Editor

Even our language has changed. Last winter, we didn’t think about lockdowns and the term social distancing was confined to sociology textbooks. The world is different.

And in our new reality, we can ask: How has the pandemic affected mental health? While there have been many small surveys (and much speculation), until now we have lacked a major, large scale survey.

This week, we look at a new paper from The Lancet Psychiatry. Matthias Pierce (of the University of Manchester) and his co-authors draw on the UK Household Longitudinal Study – a large, national survey that offers us pandemic and pre-pandemic data. The good news: “Between April and October 2020, the mental health of most UK adults remained resilient or returned to pre-pandemic levels…” but they also found that one in nine people in the UK “had deteriorating or consistently poor mental health.” We consider the big study and discuss resilience with an essay by Dr. Richard A. Friedman (of Cornell University).


In the second selection, we consider an essay by Dr. David Goldbloom (of the University of Toronto) on how the pandemic has changed psychiatry. He focuses on the biggest change: that is, the embrace of virtual care. He begins: “We are all telepsychiatrists now…” He notes the advantages and disadvantages of the transformation. While some providers express ambivalence, he writes: “What counts, ultimately, is what helps our patients.”

Finally, a reader responds to our take on The New England Journal of Medicine paper on psilocybin. Dr. Craig P. Stewart (of Western University) writes: “One area I did not see mentioned in the psilocybin paper review was a discussion of confirmation bias, which I believe also should be mentioned to contextualize the results.”


Continue reading

Reading of the Week: Perceived Helpfulness of Depression Treatment – the New JAMA Psych Paper; Also, Friedman on Boredom & the Pandemic (NYT)

From the Editor

How helpful do people find treatment for depression?

This question is broad but new work (drawing on WHO surveys) ambitiously attempts to answer it across different countries, including some that are low income.

In the first selection, we consider a paper from JAMA Psychiatry. Meredith G. Harris (of The University of Queensland) and her co-authors report on WHO data. The good news? Many people do find treatment for depression helpful. The bad news? Many providers are needed for people to believe that they had received helpful treatment.

4anvfzqDepression treatment: helpful, like a lift from a friend?

In the second selection, we look at a new essay by Dr. Richard A. Friedman (of Weill Cornell Medical College). Writing in The New York Times, he discusses the pandemic and the possibility of “a mental health epidemic of depression and anxiety.” Dr. Friedman argues that we are seeing mass boredom, not a rise in disorders like depression. While he can’t fully rule out that the pandemic will bring about an increase in mental health problems, he writes: “let’s not medicalize everyday stress.”

Continue reading

Reading of the Week: Psychiatry’s Identity Crisis

American psychiatry is facing a quandary: Despite a vast investment in basic neuroscience research and its rich intellectual promise, we have little to show for it on the treatment front.

With few exceptions, every major class of current psychotropic drugs — antidepressants, antipsychotics, anti-anxiety medications — basically targets the same receptors and neurotransmitters in the brain as did their precursors, which were developed in the 1950s and 1960s.

Sure, the newer drugs are generally safer and more tolerable than the older ones, but they are no more effective.

So begins this week’s Reading, which considers the state of psychiatry, and psychiatric research funding.

Here’s a quick summary: the author suggests that the neuroscience revolution is something of a bust and that psychotherapies are worthy of more study and use. This may seem like a strong argument. And it is – particularly given the bias of the author, who is, by his own description: “a psychiatrist and psychopharmacologist who loves neuroscience.”

This week’s Reading: “Psychiatry’s Identity Crisis” by Weill Cornell Medical College’s Richard A. Friedman was recently published by The New York Times.

The article can be found here:


Dr. Richard A. Friedman

Continue reading